Nils' own research

I am happy to advise on research anyone likes to undertake relating to skin-to-skin contact, and even more to collaborate !

On these pages I provide a brief overview of my own research.

There is a general background to the research that has been done on skin-to-skin contact, which is extensive. This brief summary reflects the work of others, and is reflected in the References and my talks, and other places as appropriate.

My first encounter with skin-to-skin contact (SCC) was in 1988, at Manama Mission Hospital. In the beginning this was not done as research, but as a novel form of care. The key departure point was to use mother’s chest as the place to stabilise low birthweight babies, rather than the incubator. The published paper is based on a comparison to the outcomes from the previous four years, when care was otherwise pretty much the same, apart from the addition of skin-to-skin contact. There was a dramatic improvement in survival, from 10% to 50% for infants below 1500g. Tropical Doctor 1994 Apr;24(2):57-60. Brief story

University of the Western Cape – MPH

From Zimbabwe I went to Cape Town South Africa, where I was able to read more deeply into the possible explanations for what I had observed. As the thesis component of my Masters in Public Health at University of the Western Cape, I did a systematic review of the relationship between skin-to-skin contact and breastfeeding, and based on this a protocol for a randomized controlled trial. It was during this time that I drew a simple model I now call the “Place Model”, which has had other names during the years. Place Model

Mowbray Maternity Hospital - First randomized controlled trial

With support and encouragement from experienced researchers, I was awarded a research grant from the Thrasher Foundation, which made possible a Randomized Controlled Trial to test the Place Model, at Mowbray Maternity Hospital. At this time, I was also appointed as Medical Superintendent at the same hospital, which allowed for better support. Using experienced neonatal nurse researchers, infants below 1200g and 2200g were randomized to spend the first six hours of life either in skin-to-skin contact, or in standard incubator care. Recruitment was very difficult, ethical approval required fully informed consent prior to birth, which in “premature” birth is challenging. Based on a pre-defined cardio-respiratory monitor based algorithm of *stable* - all skin-to-skin babies were fully stable at 6 hours. Less than half the standard care incubator babies were stable, and the smallest were even more unstable. Acta Paediatr. 2004 Jun;93(6):779-85.Abstract here

This paper states in the conclusion: “Newborn care provided by skin-to-skin contact on the mother's chest results in better physiological outcomes and stability than the same care provided in closed servo-controlled incubators.” Since servo-controlled incubators were state of the art at the time, this was the standard of reference. Biologically, SSC is the standard of reference, and the conclusion should be better stated as: “Newborn care provided by closed servo-controlled incubators results in worse physiological outcomes and stability than the same care provided in skin-to-skin contact on the mother's chest.” The editor could hardly allow such a statement to be published. The article stimulated no interest whatever, and was not cited. But two years later, John Kennell wrote in an editorial: “Publication of the report of Bergman et al. should stimulate replications by others. If these investigators' findings are confirmed, and clear guidelines for the care of premature infants in the kangaroo method in the first 6 h and beyond are published, with particular attention to warm coverings for the babies' backs, this research could benefit large numbers of premature infants in the Third World. Conclusion: As the authors indicate, skin-to-skin contact from the birth of premature infants may also be a good alternative in First World settings”.Acta Paediatrica 2006 Jan;95(1):15-6.

University of Cape Town – the neuroscience of SSC

In a small part prompted by this experience, I resigned my post at Mowbray Maternity in order to take this matter on in a more focused way. In primate studies, maternal separation causes HARM! Humans are primates - are we causing harm by separating them? I was fortunate to meet Barak Morgan in 2006, and start a research collaboration at the Department of Human Biology, University of Cape Town, where I am now an Honorary Research Associate. The underlying neuroscience of our thinking can be found on pages in this website under WHAT IS SSC. In brief: the harm that separation makes in primates is effected or mediated by cortisol, and this is released by stress, which also releases autonomic nervous system ANS activations. This ANS activity we hypothesized can be detected in Heart Rate Variability. Our first paper was published November 2011, and concludes:Maternal-neonate separation is associated with a dramatic increase in HRV power, possibly indicative of central anxious autonomic arousal. Maternal-neonate separation also had a profoundly negative impact on quiet sleep duration. Maternal separation may be a stressor the human neonate is not well-evolved to cope with and may not be benign.

Along with our cultural paradigm, the medical establishment has some difficulty with this idea that what we are doing might be harmful. Getting research funding has been a frustrating failure !! Anyone reading this who would be able to support my research, whether by funding or by collaboration, is most welcome to contact me !!!

The Place Model provides a simple scoping lens for re-examining not only our clinical care, but also our parenting culture. I have ethics approved research protocols on effects of infant crying, strict infant scheduling, fathers' hormones, as well as effects of the NICU care environment. What is really needed are long-term follow-up studies, which have to be rigorous and time consuming, and hence costly.

Skin-to-skin contact and breastfeeding are "a whole" to the newborn brain. In my thinking around this I have formulated an hypothesis around infant feeding frequency, which should be linked to brain cycling and sleep cycling. The neuroscience suggests that Homo sapiens should feed approximately every hour. Infants are able to feed as often as adults determine they should ... but what evidence is there? I suggest the stomach capacity is the clue to an answer on this.